Good plastic surgery, bad plastic surgery

Alene DawsonSpecial to the Los Angeles Times

Like it or not, plastic surgery is here to stay.

Sure, some people will tout the virtues of self-acceptance and aging gracefully and lament that the rise of cosmetic procedures (including fillers, Botox and the like) signifies the swift decline of civilization. But in reality, as long as people see a benefit — be it in their work, personal or sex lives — from looking younger or correcting perceived flaws, plastic surgery will continue to be a solution. According to statistics from the American Society of Plastic Surgeons, 13,828,726 cosmetic procedures — including the minimally invasive as well as the surgical — were done in the U.S. last year. That's a 5% increase over 2010.

But sometimes plastic surgery doesn't make a person look younger or more beautiful (an arguably subjective word). It can instead just make the person look, well, weird. For instance, Olympic champion Bruce Jenner, patriarch of the Kardashian clan, famously had the results of a mid-1980s face-lift corrected in 2009 after years of unkind commentary. Mickey Rourke, Janice Dickinson, Dolly Parton, Priscilla Presley and, of course, Michael Jackson and Joan Rivers also represent extreme transformations.

FOR THE RECORD: Plastic surgery tips: In the April 15 Image section, an article about how to get better results from plastic surgery identified Dr. Francis Palmer as an otolaryngologist. Palmer is also a facial plastic surgeon. —

"There's good surgery out there and then there is bad, at least in this town, but you just don't notice the good because those people look natural; they look rested," says Dr. Leslie Stevens, co-director of the Lasky Clinic in Beverly Hills.

For actors, having some work done can have unintended consequences.

"Jennifer Grey is a perfect example," says powerhouse casting director Victoria Burrows, a 30-year industry veteran. "She had that beautiful character nose that I think made her look pretty and then just a little nose tweak and that uniqueness went away. She became another pretty actress."

Burrows emphasizes that the majority of thespian work calls for character actors, not stars. "Character faces are fabulous — it's what we always strive to cast," Burrows says. "But what we continue to see are extreme changes, with the lips, the eyes — even with the men. It makes them look like they're surprised for months. We've had to veer away from certain actors for certain roles because they've had too much work done."

A poorly done cosmetic procedure may manifest as a look one sees see a lot in Los Angeles: that kind of overly puffy, trout-mouthed, robot-like-glaze of a Botox- and filler-injected face replete with frozen forehead and static smile lines. This look replaced the "wind-blown" face-lift look from the 1970s. Reality TV personality Heidi Montag — notorious for, at age 23, having 10 surgeries in one day (including DDD breast implants) — is just one of many celebrities (including Dana Delaney, Tori Spelling, Tara Reid, Kathy Griffin and Emmanuelle Béart) who've gone on record regretting cosmetic procedures. "If I could take it back, I would," Montag said in an interview on ABC News.

But for those contemplating having a procedure done, there are some ways to minimize the risk of surgery gone wrong, experts say.

Choose a qualified physician

Think twice before letting a gynecologist do your face-lift. This is not a joke. "Unfortunately, in most states any physician can say, 'I'm a plastic surgeon.' and do whatever they feel like doing in their office," says Dr. Malcolm Z. Roth, president of the American Society of Plastic Surgeons.

In California, a doctor performing plastic surgery must have a medical license but is not required to be certified by any particular board. But Roth recommends going to a surgeon who has hospital privileges, because that means he or she will have been vetted by professionals, and who is certified by the American Board of Plastic Surgery, one of the 24 groups that make up the American Board of Medical Specialties, or ABMS. Search for your doctor's name and specialized certification at Certificationmatters.org.

Other ABMS specialty-board certifications that may be appropriate for some procedures include dermatology, ophthalmology and otolaryngology (ear, nose and throat). Dr. Roth says that these doctors may be trained in various above-the-neck cosmetic procedures — dermatologists, for instance, may inject fillers. "But take your time choosing and see at least three doctors, including a plastic surgeon. If what you need is a face-lift, getting filler may be throwing your money down the toilet," Roth says, noting "most people do more homework deciding which new car to buy."

Don't be swayed by bargains

A Groupon, free-consultation or other cut-rate deal isn't a good enough reason to choose a doctor.

Look for skill and artistry

"Just because someone is board-certified by the ABMS or another board doesn't guarantee that they're a good artist and that you'll have a good result," says Beverly Hills plastic surgeon Dr. Garth Fisher (the doctor who repaired Bruce Jenner's face).

You should look at photos of the doctor's work, speak with other patients, verify credentials and research the doctor's reputation before you commit. (Bearing in mind that photos may be digitally altered and doctors' referrals are usually their best work, ask lots of questions.)

Communicate

"Convey what your expectations are to the doctor," says Stevens, who advocates bringing in photographs showing the results you're looking for as well as looks you don't want to end up with.

Stevens uses 3-D computer imagery to help predict outcomes. "Photographs help the doctor see what the patient's vision or expectations are," he says.

Mind details, be conservative

Research the techniques the doctor plans to use. Stevens says some can minimize scarring or avoid that pulled-back, drawn look. For eyes and brows, less is more, especially for men. "If you lift their brows too much … on men, it feminizes them. It makes them look weird," he says.

Other tipping points include putting fillers in the wrong place or adding too much volume. Otolaryngologist Dr. Francis Palmer calls an indiscriminately plumped face "the puffer fish."

"As soon as you cross the line between being adequately done and overdone — and it's a very fine line — you go from soft to puffy and swollen," Palmer says. "And as soon as you do that you will look older."

Be mindful that unlike Botox, Juvéderm and Restylane — which are temporary — certain permanent fillers and surgical procedures are irrevocable. Again, research before you choose.

Have realistic expectations

There are some cosmetic antidotes to the three Ds of aging — deterioration (fine wrinkles, veins, thinning of the skin, sun damage); descent (sagging); and deflation (losing volume). But "you can't turn the clock back that much. You have to be realistic," Stevens says.